No. MR :
Nama :
JK
Umur :
Alamat:
(S)
KU
Batuk/pilek
:(
TD
/menit
RR
/menit
BB
kg
mmHg
Hasil Lab
Hb
Eritrosit :
Leu
CT
Ht
BT
Tromb
PT/APTT
SGOT/SGPT :
Ureum/Cr
Gol. Darah
(A)
(P)
:
Infus ke.................
Transfusi darah...................kantong
FOLLOW UP ANESTESI
No. MR :
Nama :
JK
Umur :
Alamat:
(S)
KU
Batuk/pilek
:(
TD
/menit
RR
/menit
BB
kg
mmHg
Hasil Lab
Hb
Eritrosit :
Leu
CT
Ht
BT
Tromb
PT/APTT
SGOT/SGPT :
Ureum/Cr
Gol. Darah
(A)
(P)
:
Infus ke.................
Transfusi darah...................kantong
FOLLOW UP ANESTESI
No. MR :
Nama :
JK
Umur :
Alamat:
(S)
KU
Batuk/pilek
:(
TD
/menit
RR
/menit
BB
kg
mmHg
Hasil Lab
Hb
Eritrosit :
Leu
CT
Ht
BT
Tromb
PT/APTT
SGOT/SGPT :
Ureum/Cr
Gol. Darah
(A)
(P)
:
Infus ke.................
Transfusi darah...................kantong
FOLLOW UP ANESTESI
No. MR :
Nama :
JK
Umur :
Alamat:
(S)
KU
Batuk/pilek
:(
TD
/menit
RR
/menit
BB
kg
mmHg
Hasil Lab
Hb
Eritrosit :
Leu
CT
Ht
BT
Tromb
PT/APTT
SGOT/SGPT :
Ureum/Cr
Gol. Darah
(A)
(P)
:
Infus ke.................
Transfusi darah...................kantong